Influence of religious events on emergency admission in a non-Muslim country.

To the Editor: We read with great enthusiasm the publication of Taimur Butt et al on the frequency of emergencies during Ramadan.[1] They observed a day/night reversal in the volume of emergency consultations which in terms of organization results in enough staff at night and fewer during the day. To assess whether we can generalize this result to a country which is not Muslim, we conducted a retrospective study on admissions to a pediatric emergency service in Brussels. Most Muslims in Brussels attend this service. Belgian law prohibits the question of religion in the administrative data but the Muslim population is estimated to be one quarter to one third of the Brussels population by non-governmental organizations.[2]

Our study was conducted over a three-year period and included all surgical and pediatric emergency room (ER) admissions using a time-line established on the usual ER organization within our hospital. We defined three observation periods: 8h-20h, 20h-24h and 0h-12h and compared the religious event day with the seventh day before and seventh day after. Results were collected on an Excel spreadsheet and statistical analysis was carried out using the program Prism 6, GraphPad (GraphPad Software, La Jolla, California USA). An ANOVA test was carried out to compare the frequency of emergencies during the event day and the control days. A d’Agostino-Pearson test was carried out to assess the normal distribution of the population. Statistical significance was defined as P<.05.

Regarding Aïd-Al-Fitr, which celebrates the end of Ramadan, pediatric admissions were 44% fewer between 8h and 20h and 42% higher between 00h and 12h. Regarding Aid Al Adha, which is celebrated with a sheep sacrifice, trauma admissions were 18% fewer from 8h and 20h and pediatric admissions were 27% higher for the same observation time. However, no statistically significant difference was obtained when statistical analysis was carried out between the event day and the control days. Aïd-Al-Fitr being celebrated during the day, it appears that it might influence the attendance pattern since we observe a decreased number of patients during the day, which is the time of family reunion, and an increased number during the evening, which matches with the end of the celebration.

Aïd Al Adha, also celebrated during the day, did not seem to have an equal influence on ER attendance. This might be related to the fact that it is less celebrated than the previous one since the ritual sheep sacrifice, which is traditionally completed at home in Muslim countries, is forbidden by law within Belgian houses and can only be achieved in slaughterhouses. In addition, Aïds are not holidays in Europe, which would diminish the celebration rate.

Our results do not support the hypothesis that religious events influence pediatric ER attendance in a non-Muslim country. Religious events are not effective prediction tools when it comes to ER attendance within our hospital due to the population mix in our capital and to the way Muslims are practicing those events compared with practices in Muslim countries.